DESCRIPTION: (Provided by the Applicant) Preventable adverse drug events (PADE), a consequence of some medication errors, are common in the inpatient medical and pediatric settings. Risk factors most closely associated with different types of PADE have not been fully elucidated, and new tools are needed to identify specific risk factors unique to clinical microenvironments (e.g., the critical care unit). In this study, rigorous assessment tools will be used to examine the risk factors for PADE in the inpatient medical settings of four teaching hospitals, specifically examining the relationship between medication errors and extrinsic (clinical environment) and intrinsic (clinician) factors among practicing physicians and nurses. It is hypothesized that safety threats posed by extrinsic factors (clinical workload, clinical experience, task demands, work schedule) are mediated through their effects on, or interaction with, intrinsic factors (e.g., memory capacity, mood, fatigue, stress, and perception of workload). The Specific Aims are to: (1) Demonstrate the feasibility of a novel handheld instrument for real-time assessment of risk factors and error reporting; (2) Identify the types of medication errors that occur for different clinicians in different hospital settings, and characterize the risks they pose to patient safety; (3) Identify factors that contribute to medication errors and are amenable to intervention; and (4) Develop institutional-specific plans for targeted interventions likely to enhance medication safety. The study will utilize innovative risk assessment methods (ecological momentary assessment via handheld computers and structured direct observation / task analysis) to provide a real-time, multidimensional description of the interplay between clinicians and clinical work processes. Medication errors will be captured using conventional and newer methods (e.g., handheld self-reporting software and computer checks of infusion pump programming errors). Since the relationships between errors and risk factors will inform the design of interventions to prevent or reduce PADE. These results will provide new generalizable knowledge about patient safety risks that can be used to guide local and national efforts to prevent medication errors.